San Diego County MRC and the Red Cross: An Integrated ...


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San Diego County MRC and the Red Cross: An Integrated ...

  1. 1. San Diego County MRC and the Red Cross: An Integrated Response to Disasters John Hill Director of Disaster Preparedness – San Diego County Medical Society Volunteer Coordinator - San Diego County MRC
  2. 2. San Diego County MRC <ul><li>“ Sponsored” by SD County Public Health Services (PHS) </li></ul><ul><li>Development and organization contracted to SDCMS </li></ul><ul><li>MRC Coordinators include PHS and EMS staff </li></ul><ul><li>Volunteers registered with County Office of Emergency Services (OES) as Disaster Service Workers (DSW) </li></ul>
  3. 3. Disaster Shelters in San Diego County <ul><li>Operational Area Emergency Plan </li></ul><ul><li>Annex “G” – Care And Shelter Operations </li></ul><ul><ul><li>Red Cross provide bulk of Mass Care Services </li></ul></ul><ul><ul><li>HHSA and PHS will assist Red Cross </li></ul></ul><ul><ul><li>Provide trained personnel to Mass Care Shelters (PHNs) </li></ul></ul>
  4. 4. Disaster Shelters in San Diego County <ul><li>Public Health Nursing provides PHNs </li></ul><ul><ul><li>Administer first aid following Red Cross protocols </li></ul></ul><ul><ul><li>Perform health assessments to identify health problems </li></ul></ul><ul><ul><li>Perform a variety of other health related tasks: </li></ul></ul><ul><ul><ul><li>Chronic disease monitoring </li></ul></ul></ul><ul><ul><ul><li>Protect residences from communicable disease </li></ul></ul></ul><ul><ul><ul><li>Monitor food preps </li></ul></ul></ul><ul><ul><ul><li>Health education </li></ul></ul></ul>
  5. 5. Background <ul><li>Viejas and Julian Fires (2001/2002) - need to open more than 2 Disaster Shelters simultaneously </li></ul><ul><li>Public Health Nursing agreed to provide some PHNs to be trained on Red Cross Shelter Operations and Protocols </li></ul><ul><li>Training Program initiated by PHS and Red Cross for the PHNs </li></ul>
  6. 6. Background <ul><li>Fall 2003 - Cedar Fires </li></ul><ul><li>Largest wildfire in California history </li></ul><ul><li>Within 48 hours Red Cross established 12 Disaster Shelters </li></ul><ul><li>85 PHNs worked more than 100 12-hour shifts </li></ul>
  7. 7. MRC Status in 2003 <ul><li>SDCMS establishing physician volunteer network to assist PHS </li></ul><ul><li>Working with PHS to submit application for MRC grant </li></ul><ul><li>Hospital ERs not overwhelmed with victims (except for Burn Unit) </li></ul><ul><li>Did not realize health situations at shelters </li></ul><ul><li>Decision made with PHS to not activate volunteers </li></ul>
  8. 8. Cedar Fires Debrief <ul><li>RC and PH Nurses encountered large number of medical issues </li></ul><ul><ul><li>Most didn’t require transport to ER, but did not fall within protocols for treatment at shelter either </li></ul></ul><ul><ul><li>Huge number of maintenance med prescriptions </li></ul></ul><ul><ul><li>Medical supply needs such as oxygen/insulin </li></ul></ul><ul><ul><li>Not out of the norm, but volume was overwhelming </li></ul></ul><ul><li>NEED TO HAVE A SYSTEM TO MEET MEDICAL NEEDS OF VICTIMS IN SHELTERS!! </li></ul>
  9. 9. Developing the Partnership <ul><li>Brainstorming session </li></ul><ul><li>County </li></ul><ul><ul><li>EMS Disaster Coordinator </li></ul></ul><ul><ul><li>Lead PHN </li></ul></ul><ul><ul><li>MRC Coordinators </li></ul></ul><ul><li>Red Cross </li></ul><ul><ul><li>Disaster Health Services Directors </li></ul></ul><ul><ul><li>Lead Physician </li></ul></ul><ul><ul><li>Lead Nurse </li></ul></ul>
  10. 10. Developing the Partnership <ul><li>Brainstorming session </li></ul><ul><ul><li>Educated each other! </li></ul></ul><ul><ul><li>Discussed what had been needed in fires </li></ul></ul><ul><ul><li>Discussed what could possibly have been done </li></ul></ul><ul><ul><li>Discussed liability (RC vs. DSW) to ensure RC immune </li></ul></ul><ul><ul><li>Discussed RC notification that MRC is needed </li></ul></ul><ul><ul><li>Next steps </li></ul></ul>
  11. 11. Developing the Partnership <ul><li>Public Health Nurses </li></ul><ul><ul><li>PHS and Red Cross developed training curriculum </li></ul></ul><ul><ul><ul><li>Red Cross Shelter Operations </li></ul></ul></ul><ul><ul><ul><li>Red Cross Disaster Health Services Protocols </li></ul></ul></ul><ul><ul><ul><li>MRC capabilities and interaction </li></ul></ul></ul><ul><li>Over 180 PHNs trained </li></ul>
  12. 12. Developing the Partnership <ul><li>MRC Advisory Board </li></ul><ul><li>Red Cross represented by: </li></ul><ul><ul><li>RC Physician </li></ul></ul><ul><ul><li>RC Lead Nurse </li></ul></ul><ul><ul><li>Disaster Health Services Staff </li></ul></ul><ul><li>MRC adopted Disaster Shelters as a core mission </li></ul>
  13. 13. Developing the Partnership <ul><li>Developed notification procedure </li></ul><ul><li>Developed shelter layout structure </li></ul><ul><li>Developed client flow to include medical </li></ul><ul><li>Determined the scope of practice for MRC would be defined during activation by Public Health Officer </li></ul><ul><li>No need for MOU since already in Annex G </li></ul>
  14. 14. Hurricane Katrina <ul><li>1 st MRC Activation </li></ul><ul><ul><li>Notified by EMS of possible evacuees arriving in SD </li></ul></ul><ul><ul><li>Sept 2 nd : conference call w/Red Cross, County, DHS.. </li></ul></ul><ul><ul><li>Sept 3 rd : conference call at 1800 hrs </li></ul></ul><ul><ul><ul><li>Shelter being established for up to 170 evacuees arriving via plane on Sept 4 th </li></ul></ul></ul><ul><ul><li>Called 9 volunteers, reached or left message with 8 </li></ul></ul>
  15. 15. Hurricane Katrina <ul><li>3 MDs and 5 RNs mustered at shelter </li></ul><ul><ul><li>MRC/RC established medical location and client flow </li></ul></ul><ul><ul><li>MRC brought basic medical items </li></ul></ul><ul><ul><li>RC provided first aid materials, purchased additional supplies and made arrangements to fill prescriptions </li></ul></ul><ul><ul><li>Deputy PHO assigned to establish scope of practice </li></ul></ul>
  16. 16. Hurricane Katrina <ul><li>80 evacuees arrived approx 1900 hrs </li></ul><ul><ul><li>All seen by PHNs under RC protocols </li></ul></ul><ul><ul><li>35 referred to MRC RNs and MDs </li></ul></ul><ul><ul><li>Performed medical assessments/exams </li></ul></ul><ul><ul><li>Wrote prescriptions </li></ul></ul><ul><ul><li>Referred for follow up </li></ul></ul><ul><ul><li>1 transport to ER </li></ul></ul><ul><ul><li>MRC deactivated at 2230 hrs </li></ul></ul>
  17. 17. Hurricane Katrina <ul><li>Throughout week of Sept 5 th prepared for arrival of FEMA flights </li></ul><ul><li>Red Cross was lead agency </li></ul><ul><ul><li>MRC/Disaster Health Services developed shelter layout at local university for 600 </li></ul></ul><ul><ul><li>MRC communication system to solicit volunteers </li></ul></ul><ul><ul><li>Activated 2 MRC MDs to see clients at RC offices </li></ul></ul><ul><ul><li>MRC pharmacist system to assist filling prescriptions </li></ul></ul><ul><ul><li>RC established Family Assistance Center (FAC) </li></ul></ul>
  18. 18. Hurricane Katrina <ul><li>Sept 10 th to Oct 14 th at FAC </li></ul><ul><ul><li>17 physicians volunteered for 79 4-hour shifts </li></ul></ul><ul><ul><li>12 nurses volunteered for 21 4-hour shifts </li></ul></ul><ul><ul><li>3 pharm techs volunteered for 7 4-hour shifts </li></ul></ul><ul><ul><li>More than 2300 clients registered at FAC </li></ul></ul><ul><ul><li>Nurses from RC, PH, and MRC saw 547 under RC protocols </li></ul></ul><ul><ul><li>339 needed to be seen by MRC physicians </li></ul></ul>
  19. 19. Hurricane Katrina <ul><li>Sept 10 th to Oct 14 th at FAC </li></ul><ul><li>What did they do? </li></ul><ul><ul><li>Performed medical assessments/exams </li></ul></ul><ul><ul><li>Wrote prescriptions </li></ul></ul><ul><ul><li>Worked with community clinics on referrals/follow up </li></ul></ul><ul><ul><li>Provided emotional comfort and support </li></ul></ul><ul><ul><li>Arranged transport to ER or Urgent care if needed </li></ul></ul>
  20. 20. Hurricane Katrina <ul><li>Identified a need to better fill prescriptions </li></ul><ul><ul><li>Some MRC physicians brought sample meds </li></ul></ul><ul><ul><li>Solicited other MRC and SDCMS physicians </li></ul></ul><ul><ul><li>MRC pharmacists and pharm techs inventoried </li></ul></ul><ul><ul><li>Allowed for onsite filling of the common prescriptions </li></ul></ul><ul><li>Saved the local RC chapter thousands $$ </li></ul>
  21. 21. Lessons Learned <ul><li>MRC needs more medical supplies than RC or PHN carry </li></ul><ul><li>Medical location in shelter set up </li></ul><ul><li>MRC protocols “tailored” for each event </li></ul><ul><li>Scope of practice set by PHO each time </li></ul><ul><li>Collaborate with RC on training programs/drills </li></ul><ul><li>Train MRC nurses and physicians on RC forms </li></ul>
  22. 22. Lessons Learned <ul><li>Develop J-I-T training on Shelter Ops </li></ul><ul><li>Train the PHNs on MRC volunteer management </li></ul><ul><li>Develop MRC patient forms </li></ul><ul><li>For long term shelters, establish watch bill system </li></ul><ul><li>Identify common issues and establish prescription plan </li></ul>
  23. 23. QUESTIONS?
  24. 24. John Hill [email_address] 619-285-6452